1184603656 NPI number — MEGAN SUZANNE O'NEILL PA-C

Table of content: MEGAN SUZANNE O'NEILL PA-C (NPI 1184603656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184603656 NPI number — MEGAN SUZANNE O'NEILL PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'NEILL
Provider First Name:
MEGAN
Provider Middle Name:
SUZANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184603656
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 UPPER RAGSDALE DR
Provider Second Line Business Mailing Address:
SUITE B-200
Provider Business Mailing Address City Name:
MONTEREY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93940-5736
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-375-6334
Provider Business Mailing Address Fax Number:
831-375-6331

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 UPPER RAGSDALE DR
Provider Second Line Business Practice Location Address:
SUITE B-200
Provider Business Practice Location Address City Name:
MONTEREY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93940-5736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-375-6334
Provider Business Practice Location Address Fax Number:
831-375-6331
Provider Enumeration Date:
01/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  085002580 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 001671 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 15-01137 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: PA21197 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 421060724 . This is a "BILLING TAX ID# FOR CHC" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 421060724B7 . This is a "JOHN DEERE HEALTH" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 109573 . This is a "HEALTH ALLIANCE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 5100918 . This is a "CONTROLLED SUBSTANCEE #" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 04233 . This is a "IOWA BC/BS IN DAVENPORT" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: IA01B7 . This is a "JOHN DEERE EDI#" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".